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Treatments and Seizure Outcome of 327 Patients with Infantile Spasms: A Retrospective Analysis

Infantile spasms (IS) are a severe infantile seizure disorder, which can cause significant morbidity in children. Several factors affect developmental outcome, but the knowledge of their etiology and pathogenesis is still evolving. Though many management strategies vary among different centers, still little is known about the pathophysiological basis for IS and treatment remains problematic. This study aims to evaluate the treatment and seizure outcome for IS. This was a retrospective case study over 12 years of children with IS who were treated at our center. A positive response to therapy was defined as a two-week spasm-free interval. Of the 346 children, 327 were included for this study. The response rate for adrenocorticotropic hormone (ACTH) was 71% and 62% for high-dose oral corticosteroids (OCS). Both groups had similar response rates, which had significantly better response than the low-dose OCS group and the antiseizure medication (ASM) treatment group. Cessation of spasms was achieved faster in the group receiving steroid combined with ASM. The unknown eitology group had better neurodevelopmental outcome (OR 2.431 (1.025-5.768) ), p=0.044). At our center, steroids are now the preferred choice for initial therapy of infantile spasms. Early introduction of ACTH combined with ASM therapy for spasms may predict a good neurodevelopmental outcome. Children with cryptogenic spasms is likely to have a beneficial neurodevelopment. Spasms in 25% of the patients tend to be refractory, and the majority of patients from the cohort continue to have epilepsy with motor and cognitive disabilities.
Keywords: infantile spasms, ACTH, oral corticosteroids, antiseizure medication, psychomotor development

Yinjie Ling
first people's hospital of Huzhou, Huzhou, China
China

Peifang Jiang
Children’s Hospital, Zhejiang University School of Medicine
China

 

 


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